Legal & regulatory: No more boots on the ground
Katherine Wackett, senior associate from Mills & Reeve, explains the expected effect of the Care Quality Commission’s new single assessment framework on in-person inspections
As healthcare providers will be aware, the Care Quality Commission is introducing its new ‘single assessment framework’ in April. The practical detail of how this will work is not entirely clear and no doubt the CQC will need to refine the process once it begins rolling it out.
However, what’s clear is there is a shift away from in-person inspections and a move towards evidence collection and reliance on third-party intelligence. The CQC is changing its process from ‘inspection’ to ‘assessment’ and away from its ‘boots on the ground’ approach.
Quality statements and evidence categories
The CQC is replacing its current ‘Key Lines of Enquiry’ with 34 ‘Quality Statements’ or QS. These QS relate to areas across the five key questions of: safe, effective, responsive, caring and well-led.
In order to assess services against these QS, the CQC has set out six categories of evidence that it will assess, and each evidence category will be scored from 1 to 4.
The six evidence categories are:
- People’s experiences of health and care services.
- Feedback from staff and leaders.
- Feedback from partners.
- Observation.
- Processes.
- Outcomes.
Observation is the fourth evidence category in the CQC’s new inspection regime and includes both off-site and on-site observations.
It’s clear from these evidence categories that the CQC is moving away from its traditional approach based on inspection of services on site, with only one category out of six being directly based on what CQC inspectors observe at a service. The evidence category of ‘Observation’ will, however, include off-site observations gathered from local Healthwatch and other partners and via the Experts by Experience programme. Where evidence from these other bodies is about the care environment, this will be included in Observation rather than the Feedback categories.
The other five evidence categories all rely on non-observational evidence.
As a result, we expect physical inspections of services to take place only where there are concerns or where evidence gathering can only be done on site.
Impact on care homes
This new approach means care homes need to be more proactive in their approach to CQC regulation. Rather than responding to a CQC inspection that may take place once every two or three years, providers will need to provide evidence proactively to the CQC on an ongoing basis. The idea behind this is to allow the CQC to provide a dynamic up-to-date assessment of risk and enable it to reassess service providers much more frequently than it does under the current inspection framework.
The CQC’s provider portal is likely to play a pivotal role in this new framework and is, according to the CQC, going to allow the easy exchange of information.
As each of the 34 QS are going to be scored, it would be prudent for care providers to map what evidence can be used to demonstrate that each of these QS are met and ensure that such evidence is readily available to provide to the CQC.
To ensure care homes are ready for this change, systems may need to be updated to ensure this information can be exchanged with the CQC on an ongoing basis.
